Combined aromatase, CDK4/6 and PI3K blockade using letrozole/abemaciclib/LY3023414 in endometrial cancer

Several lines of preclinical evidence indicate that combining PI3K and CDK4/6 inhibitors may further enhance the efficacy of hormonal therapy by overcoming de novo and acquired resistance to PI3K and CDK4/6 blockade. We evaluated the combination of abemaciclib, letrozole and LY3023414 (an orally available, selective inhibitor of the class I PI3K isoforms and mTORC1/2) in recurrent endometrial cancer (EC). This study was terminated prematurely after 5 patients initiated protocol therapy due to discontinuation of further development of LY3023414. We report our findings from these patients, including one with recurrent endometrioid EC with AKT1, CTNNB1 and ESR1 hotspot mutations who had previously progressed through letrozole/everolimus and achieved a partial response to letrozole/abemaciclib/LY3023414.

Trends in adolescent COVID-19 vaccination receipt and parental intent to vaccinate their adolescent children, United States, July to October, 2021

INTRODUCTION

There was a five-fold increase in COVID-19 hospitalization case counts among children and adolescents between June and October 2021. However, polls suggest that adolescent COVID-19 vaccination coverage has plateaued in the United States.

METHODS

Using the Census Bureau's Household Pulse Survey, we assessed trends in COVID-19 vaccination among adolescents ages 12-17 years, parents' intention to vaccinate their adolescent children, and their reasons for not intending to vaccinate their children from July to October 2021 using a large, nationally representative survey of U.S. households (n = 59,424). Trends in COVID-19 adolescent vaccination coverage, nationally and by sociodemographic characteristics, factors associated with adolescent vaccination status and parental intent to vaccinate their adolescent children, as well as changes in reasons for non-vaccination were examined using regression models.

RESULTS

Receipt of ≥1 dose of a COVID-19 vaccine among adolescents ages 12-17 years increased five percentage points, from 56% (July) to 61% (October), with significant increases across most sociodemographic variables. However, there were no significant changes in parental intention to vaccinate their adolescent children during the same time period. Approximately one-quarter of parents were unsure about or reluctant to vaccinate their children, which remained consistent from July to October. Among those who had not vaccinated their children, lack of trust in the government and vaccines, and the belief that the COVID-19 vaccine is not needed or effective, was higher in October compared to July.

CONCLUSIONS

Parental intention to vaccinate their children has remained relatively stable throughout the late summer and early fall of 2021. Encouraging paediatricians to discuss the importance and safety of COVID-19 vaccines, addressing concerns and misinformation, as well as recommending and offering vaccines are important for increasing parental confidence in vaccines as well as vaccination uptake among adolescents.KEY MESSAGEReceipt of ≥1 dose of a COVID-19 vaccine among adolescents ages 12-17 years increased five percentage points, from 56% (July) to 61% (October), with significant increases across most sociodemographic variables.Approximately one quarter of parents were unsure about or reluctant to vaccinate their children, which remained consistent from July to October.Encouraging paediatricians to discuss the importance and safety of COVID-19 vaccines, addressing concerns and misinformation, as well as recommending and offering vaccines is important for increasing parental confidence in vaccines as well as vaccination uptake among adolescents.

An MDS-specific frailty index based on cumulative deficits adds independent prognostic information to clinical prognostic scoring

The frailty index (FI) is based on the principle that the more deficits an individual has, the greater their risk of adverse outcomes. It is expressed as a ratio of the number of deficits present to the total number of deficits considered. We developed an MDS-specific FI using a prospective MDS registry and assessed its ability to add prognostic power to conventional prognostic scores in MDS. The 42 deficits included in this FI included measurements of physical performance, comorbidities, laboratory values, instrumental activities of daily living, quality of life and performance status. Of 644 patients, 440 were eligible for FI calculation. The median FI score was 0.25 (range 0.05-0.67), correlated with age and IPSS/IPSS-R risk scores and discriminated overall survival. With a follow-up of 20 months, survival was 27 months (95% CI 24-30.4). By multivariate analysis, age >70, FI, transfusion dependence, and IPSS were significant covariates associated with OS. The incremental discrimination improvement of the frailty index was 37%. We derived a prognostic score with five risk groups and distinct survivals ranging from 7.4 months to not yet reached. If externally validated, the MDS-FI could be used as a tool to refine the risk stratification of current clinical prognostication models.

Cancer Mortality in Italian Migrants to Canada

The present study reports on the analysis of cancer mortality in Italian first-generation migrants resident in Canada, deceased in the period between 1964-1985 (5,801 males: 3,267 females). Mortality in migrants is compared to that of the host population as well as to that in the migrants’ country of origin. This is carried out both on a national level (Italy), and on a regional level with those regions that have made the greatest contribution to the Italian migratory flow (Southern Italy). Compared with the Canada-born population, significantly higher risks were evident for nasopharynx, stomach, liver and gallbladder tumors in migrants. Lower risks were observed for the oral cavity, esophagus, colon, rectum, pancreas (females), larynx, lung, melanoma, breast, ovary, prostate, bladder (females), and non-Hodgkin's lymphoma in migrants. This is consistent with that evidenced in the comparison between Italy and Canada. The data are discussed in relation to the results of other studies on Italian migrants and the prevalence of main risk factors.

Epidemiology of Classic Kaposi's Sarcoma, with Special Reference to Mediterranean Population

An excess of classic Kaposi's sarcoma (KS) in individuals of southern European ancestry has long been suspected and recently quantified in terms of age-standardized rates. In Italy and most notably in southern Italy for the period 1976-84, prior to the AIDS epidemic, KS incidence rates were two-to-three-fold higher than in the United States and Sweden and many ten-fold higher than in England and Wales and Australia. A high frequency of classic KS has also been documented in Israel and, in low-risk countries, in individuals born in southern Europe and the Middle East. Many infections have been suspected to play a role in the etiology of KS, including cytomegalovirus, malaria and, most recently, a new virus of the herpes family, identified in AIDS-associated and classic KS. The present review deals with epidemiologic data concerning KS in the Mediterranean and stresses the opportunity to combine the study of KS in AIDS as well as non-AIDS patients in order to shed light on this no longer rare disease.

The Accuracy of Local Death Certificates in Cancer of the Lung and Stomach

The study analysed the accuracy of local death certificates (LDC) for patients with lung cancer (424 males, 36 females) and stomach cancer (99 males, 62 females) who died between 1979 and 1984. All the diagnoses were confirmed histologically. For a subgroup of lung cancer (males), we also evaluated the national death certificate (NDC) and the correspondence of LDC vs. NDC. The reliability of LDC was quite poor. This paper examines the different reasons for the underevaluation of cancer in LDC and the variables which modify the accuracy of cause of death on the death certificate.

Analysis of Trends in Cancer Mortality in Italy 1951-1978; The Effects of Age, Period of Birth, and Period of Death

We describe trends in cancer mortality in Italy between 1951 and 1978 for 6 different sites (esophagus, lung, breast, cervix uteri, testis, and bladder) as well as all cancers. This is done using a statistical model which separates the contributions associated with age, period of birth and period of death. The results are related to equivalent analyses in England and Wales and also to trends in lifestyle in Italy (alcohol consumption, cigarette consumption, birth rates).

Cell Type Distribution in Histologic Specimens of Primary Lung Cancer

A total of 1986 cases of primary lung cancer, observed in the Pathology Department of the University of Florence during 1971–1981, were analysed by age, sex, year of diagnosis, source of specimen, and cell type. Adenocarcinomas occurred more frequently in females and at younger ages and were diagnosed mainly from surgically obtained specimens. In contrast, squamous cell carcinomas developed more often in males and at older ages, and were chiefly diagnosed by bronchial biopsy. Over the 11-year period of study, a significant increase in the percentage of squamous cell carcinomas and a consequent decrease in the percentage of adenocarcinomas occurred both in females and in males, independent of changes in the specimen sources.

Hematopoietic cell transplantation for Crohn’s disease; is it time?

AIM: To review all studies in the literature that have assessed Hematopoietic cell transplantation (HCT) and Crohn’s disease (CD) with the ultimate aims of determining if this is a viable treatment option for those with CD. A secondary aim was to review the above literature and determine if the studies shed further light on the mechanisms involved in the pathogenesis of CD.

METHODS: An extensive Medline search was performed on all articles from 1970 to 2005 using the keywords; bone marrow transplant, stem cell, hematopoietic cell, Crohn’s disease and inflammatory bowel disease.

RESULTS: We identified one case in which a patient developed CD following an allogeneic HCT from a sibling suffering with CD. Evidence for transfer of the genetic predisposition to develop CD was also identified with report of a patient that developed severe CD following an allogeneic HCT. Following HCT it was found that the donor (that had no signs or symptoms of CD) and the recipient had several haplotype mismatches in HLA class III genes in the IBD3 locus including a polymorphism of NOD2/CARD15 that has been associated with CD. Thirty three published cases of patients with CD who underwent either autologous or allogeneic HCT were identified. At the time of publication 29 of these 33 patients were considered to be in remission. The median follow-up time was seven years, and twenty months for allogeneic and autologous HCT respectively. For patients who underwent HCT primarily for treatment of their CD there have been no mortalities related to transplant complications.

CONCLUSION: Overall these preliminary data suggest that both allogeneic and autologous HCT may be effective in inducing remission in refractory CD. This supports the hypothesis that the hemolymphatic cells play a key role in CD and that resetting of the immune system may be a critical approach in the management or cure of CD.

Effect of medroxyprogesterone pretreatment on pentagastrin-induced panic symptoms in females with panic disorder

Clinical observation, as well as epidemiological and research data, suggest that female gonadal hormones influence the course of panic disorder (PD). Panicogenic agents such as pentagastrin are useful tools with which to study the pathophysiology of panic attacks. Nine women with PD were randomly assigned to receive, in a crossover design, a 3-day pretreatment with medroxyprogesterone acetate (MP) prior to an injection of pentagastrin, and a 3-day pretreatment with a placebo prior to another injection of pentagastrin. The panic response and the anxiety response to pentagastrin were decreased after MP pretreatment. These preliminary results support the use of laboratory models for investigations of the interactions between progestins and anxiety.

[Etiological epidemiology of colorectal tumors]

We reviewed the main results of colon cancer (CC) epidemiologic studies, according to data published in the 1973-1994 period, with a particular mention to dietary factors and to differences with Italian findings. Meat (mostly, red meat), animal fats and high energy intake not counterbalanced by sufficient physical activity seem to be the most consistent risk factors for CC. On the contrary, the vegetarian based diet seems to reduce the risk of CC. Although interestingly, the relevance to CC of other life-style and diet-related factors (alcohol intake, smoking habits, processing and cooking methods, occupation, drugs, personal medical and reproductive history) must be better defined and requests further investigations. More recently, genetic studies are clarifying the hereditary risk of CC. Several colon carcinogenesis hypotheses have been proposed, but general agreement on the most reliable is still lacking. Authors argue that in the next future, new acquirements could emerge from metabolic polymorphism studies, possibly reconciling the biological significance of individual susceptibility and environmental factors to CC incidence.

[Gastrointestinal system tumors in Italian emigrants]

In this paper we present the risk of death for stomach, colon, rectum and pancreas cancers in Italian migrants to Canada, Argentina, Australia, France and England and Wales. Estimations of relative risks (RR) in Italian migrants, in residents in Italy and in Southern Italy relative to the local born in the host country are shown. Relative risks in Italian migrants to Australia were analysed also by duration of stay in the host country. The Italian migrants' cancer profile in intermediate between the origin and the host population: a reduction of risk of death for stomach cancer and an increase of risk for colorectal cancers are the main results. The results are discussed taking into account the analysis by duration of residence and the pattern of food prevalent in the different countries considered.

The use of complementary therapies by breast cancer patients attending conventional treatment

The aim of this study was to measure the proportion and characteristics of complementary therapy (CT) users among female breast cancer patients receiving conventional treatment. 473 women who had received surgical intervention for breast cancer in the year of diagnosis were sent a questionnaire for completion, and 242 responded. CT had been used by 16.5% after cancer diagnosis, only 8.7% before. The most commonly used CTs were homeopathy, manual healing method, herbalism and acupuncture. The main reason for using CTs was physical distress. Only a minority was searching for psychological support. 24 users were satisfied with these treatments, and two-thirds would suggest them. Users were significantly younger, more educated, and previous users of CTs than non-users. Adjusting each variable for the effect of the others, only previous use had an independent effect on increasing the probability of being users after cancer diagnosis.

[Hospital admissions, diagnostic and therapeutic procedures of patients with colorectal cancer during 5 years after diagnosis: population-based study]

This research evaluated basic parameters of care, also in the terms of costs. The study examined a sample of colorectal cancer cases incident in 1987 in the population of Florence's municipality, taken from the data base of Tuscany Cancer Registry (RTT). We collected, for 71 patients, all clinical records, for the five follow-up years and evaluated the diagnostic and therapeutic procedures (blood tests, histologic examination, instrumental investigation and surgical intervention) and the duration of all hospitalisations. Besides, on the basis of the diagnostic and therapeutic procedures and of the discharge diagnosis, each hospitalisation was coded following the DRG system and the economic cost of hospital care was analysed. The average number of hospitalisations and the average length of stay for patient in five follow-up years are respectively 1.9 (SD = 1.3) and 41.3 (SD = 25.8); the length of stay resulted highly correlated with the stage of disease. The mean hospital cost per patient (about ItL 18.000.000 overall) was higher in patients with more advanced disease at diagnosis. In the period of study an average 125.9 blood tests (SD = 110.7), 1.2 histologic examinations (SD = 0.9) and 10.3 instrumental investigations (SD = 9.0) were performed for each patient; 61 subjects (86%) were submitted to surgical intervention, of which 4 had a second intervention, and 1 subject was submitted to surgical intervention for liver's metastases.

Malignant melanoma in Europe: changes in mortality rates (1970-90) in European Community countries

Reducing mortality, especially premature death, is a major goal of the fight against cancer. In this study, we have analyzed trends in malignant melanoma (MM) mortality in the European Community (EC) as a whole and for each country. The data (obtained from the World Health Organization data bank) have been analyzed for the period 1970-90, by age groups (20-44, 45-64, 65-74, 75+ years). Trends are presented as percentage change of mortality rate for each three-year period in comparison with the rate in the first one (1970-72). The mortality from MM in the EC as a whole increased for both genders (men, +89.2 percent; women, +72.6 percent), with statistically significant trends in all age classes. Northern countries experienced mortality changes about 30 to 50 percent less than the EC average increase. Greater changes were seen in southern European countries, in which recent standardized rates are near to those observed in northern European populations. Among Mediterranean people, the highest increase (more than fourfold) was observed in Spain. The significant increase found for the younger age class makes unlikely the risk of misclassification with other skin cancers. No future decrease in MM mortality in the EC is indicated from these data.

Survival of classic Kaposi's sarcoma and risk of second cancer

In order to elucidate survival rates and risk of second primary cancer, we assessed 204 patients with histologically confirmed classic Kaposi's sarcoma (KS) who were identified in 11 Italian population-based cancer registries. One hundred and thirty-nine were men (median age 70 years) and 65 were women (median age 72). One, 5 and 10 year survival rates were 0.92, 0.69 and 0.46 respectively. Median survival was 9.4 years (i.e. not different from the Italian general population of the same sex and age). Survival did not vary according to sex and tumour site (i.e. lower limbs only or other). Eleven second primary cancers, including two lung and two kidney cancers, were reported after KS diagnosis (not different from the expected number).

Colorectal, lung, and breast cancer care during the three years following the diagnosis: a population-based study

AIMS

We evaluated a number of basic parameters of care during hospitalization that contribute to the total cost of therapy during the 3 years after the first diagnosis of cancer.

METHODS

The study examined a sample of cases of cancer of the colon-rectum (164 cases), lung (160 cases) and breast (144 cases) diagnosed in 1987, taken from the data base of the Tuscany Cancer Registry. All the information collected by the Registry was examined and the sample was further validated by reviewing original clinical records. The agreement between the two sources was very high, confirming the adequacy of the Registry as a source of information. The parameters evaluated for each patient were the number of cytohistologic examinations, surgery, hospital admissions and days spent in hospital during the 3 follow-up years.

RESULTS

The average number of admittances in 3 years was 1.93 for colorectal, 3.39 for lung and 2.15 for breast cancer. The mean number of days spent in hospital in the 3 follow-up years was 39.9 for colorectal, 50.1 for lung and 21.1 for breast cancer. The parameters differed among subjects still alive, those deceased and those in various stages of the illness.

CONCLUSIONS

The costs of the time spent in hospital, based on the number of days during the first 3 years of the illness, were higher in cases of lung cancer than of the other sites, and more so for patients diagnosed in an advanced phase of the disease.

Cancer mortality in Italian migrants and their offspring in Canada

Studies on the offspring of migrants provide important information on the contribution of environmental and genetic factors in the etiology of various cancers. The aim of the present study is to analyze the cancer risk in Italian-migrants (Canadian residents born in Italy) and their offspring compared with the host population. Odds ratios (OR) and 95 percent confidence intervals (CI) by site and birthplace categories (migrants, pure and mixed Italian-parentage Canadians) were calculated by means of a case-control study using the 'other cancer deaths' as controls and taking the host population as the reference category. The study shows that Italian migrants retain a significantly low risk for a series of cancers: colon (OR = 0.9 in males and 0.7 in females); lung (OR = 0.8 in males and 0.5 in females); and breast (OR = 0.9). For all of these sites, risks in the offspring of Italian migrants were not different from those of the host population, with some differences between the genders with respect to cancer of the colon. Stomach cancer presents a significantly high rate in migrants (OR = 1.9 in males and 2.4 in females), consistent with the population of Italy; in their offspring, risks are similar to those in the host population. The risk of cancer in the offspring of migrants is, for many sites, intermediate between the host population and the Canadian residents born in Italy. This finding possibly is related to the larger integration of the offspring than their parents in the cultural and social environment of the host population.

Population-based breast cancer survival. Mammographic screening activities in central Italy

BACKGROUND

The aim of this study was to evaluate the effect on 5-year survival of patients with invasive breast cancer relative to demographic and clinical variables (age, residence, and disease diffusion) and to early diagnostic procedures performed in the area.

METHODS

The observed (Kaplan-Meier method) and relative 5-year survival in 1263 patients with invasive breast cancer in the Province of Florence, Italy, between 1985-1986 (source: Tuscany Cancer Registry) are presented. The results were compared with those of other European areas and of the Surveillance, Epidemiology, and End Results Program. The Cox model is used to evaluate the effects of age at diagnosis (5-year age groups), disease diffusion (localized, regional, distant, unspecified), residence (Municipality of Florence, screening area, other municipalities), and source of diagnosis (Center for the Study and Prevention of Cancer, hospitals) on observed survival.

RESULTS

Observed 5-year survival was 68.4% (Kaplan-Meier method) and relative 5-year survival was 75.4%. Relative survival for patients younger than age 35 at diagnosis was high (82.3%); it decreased slowly from 80.5% in the group of patients 35-44 years of age, to 74.0% in those 65-74 years of age, and steeply decreased to 68.1% in those 75 years of age and older. Relative 5-year survival in Florence was lower only than that observed in Switzerland (Geneva) and in the USA (whites). Five-year prognosis was worse in women 70 years of age or older, in advanced stages, in residents of municipalities not involved in the screening program, and in cases diagnosed in hospitals. The gain in survival may be explained partially by lead-time effect and by length bias due to early diagnosis both in self-referred women and in screening-detected cases. In these cases, though, the better prognosis, although attenuated, persisted after adjustment by disease diffusion.

CONCLUSIONS

The results suggest that the early diagnosis of breast cancer in self-referred women affects prognosis, at least concerning 5-year survival. Moreover, although lead-time effect and length bias cannot be excluded in this study, screening by personal invitation may reduce the disadvantage in the survival of patients with breast cancer often observed in rural areas.

[The immigration of Italian patients to foreign countries. Analysis of the Gustave Roussy Institute series]

Most Italian patients who migrate to foreign countries to receive health care, choose France. The Gustave Roussy Institute (IGR) located in Villejuif, a town in the suburbs of Paris, is one of the most important center for cancer diagnosis and treatment in France. The aim of this issue has been to evaluate the admissions of Italian patients in terms of cause of admission, treatment and area of residence of the patients. We analysed the series of Italian patients admitted to IGR from 1988 to 1991; during that period 8159 Italian patients were hospitalized (2.8% younger than 15 years, 84.3% between 15 and 64 years and 12.9% older than 64 years). Most of those patients were resident in the South of Italy (more than 63%) and in particular they came from the region Sicily (27.4%) and Campania (18.8%). A different pattern seems to distinguish patients coming from the Center and the North of Italy from those from the South. In fact the aim of this migration was, for the former, a consultation on the therapy that they had, in large part, already undergone in Italy while the latter wanted to start their treatment there. The admissions related to the three most frequent cancers (breast, lung, lympho-hemopoietic system) have been analysed. The majority of patients were from the South of Italy. Breast cancer patients have migrated to the IGR looking for a post-surgical treatment while lung patients have been in large part treated for the first time at the IGR.

Kaposi's sarcoma in Italy before and after the AIDS epidemic

The incidence of Kaposi's sarcoma (KS) in 1976-90 was assessed in Italy, taking advantage of a network of nine population-based cancer registries covering, at its maximum, approximately 5.6 million subjects. The first examined period (1976-84) substantially reflects the epidemiology of KS prior to the AIDS epidemic in the registration areas. Elevated incidence rates, standardised to the Italian population of 1981, of 1.05/100,000 men and 0.27/100,000 women emerged in 1976-84 (i.e. from two- to threefold higher than in the USA and Sweden, more than tenfold higher than in England and Wales). These high rates, especially remarkable in the Registry from the south of Italy (i.e. Ragusa, 3.01/100,000 men and 0.54/100,000 women) suggest that the prevalence of the still unknown causative agent for KS was high, at least in some parts of Italy, prior to the AIDS epidemic. In the most recent period (1985-90), an approximately twofold increase in KS incidence rates in Italian men below age 50 was observed (from 0.15 in 1976-84 to 0.47 in 1985-90). Conversely, declines in KS incidence were recorded in older men.

Progress in the fight against cancer in EC countries: changes in mortality rates, 1970-90

The question of how much effective progress against cancer is being made has been raised repeatedly during the last decade; one approach to evaluating such progress is represented by the analysis of mortality, which has been used by several researchers. Here we report mortality trends for 1970-90 for four age-groups, calculated for each 3-year period, and presented as the percentage change of the rate of the first period examined. Detailed graphs for each country and for the European Community as a whole are presented for 'all cancers', and for cancer of the colon-rectum, lung, breast and ovary. For other cancers (stomach, melanoma, uterus, testis and Hodgkin's disease), the graphs are presented only for the whole of the European Community. Variations in mortality are discussed, in terms of changes in incidence, efficacy and diffusion of prevention, as well as improvement in diagnosis and treatment.

Nasopharynx cancer in Italian migrants

Incidence and mortality for nasopharynx cancer in Italian migrants to Australia, Brazil (Saõ Paulo), Canada, England and Wales, France, Uruguay, and the United States (Connecticut; Los Angeles and San Francisco, California) are analyzed. While the available incidence and mortality rates in the south of Italy--from where a large majority of migrants derive--are comparable to or lower than the other Western countries, the study shows a high risk in Italian migrants compared with the locally-born populations. These results are consistent in both sexes and in all host countries with the exception of the two South American ones. This finding possibly reflects a migration from some Italian sub-areas at higher risk, consistent with the high risk reported for some other Mediterranean populations (Maghreb, Malta).

[Diffusion of smoking habit in the commune of Florence in 1989]

The results of a study on smoking habits of Florence inhabitants (14 years of age or more) are reported. A random sample of general population of the town (1744 males and 1977 females) was recruited throughout the registration office and interviewed by mail or telephone. General compliance was approximately 85%. Thirty-seven percent of males and 25% of females were current cigarette smokers, 29% of males and 11% of females were ex smokers. Males were heavier smokers both as concerns duration of the habit and daily amount of cigarettes. In males born after 1930 the smoking prevalence decreased gradually by period of birth, while it increased in females born before 1960. As a result the smoking habits of younger cohorts were similar in males and in females. In each sex age-adjusted smoking prevalence showed important differences by educational groups and in respect to national averages.

Female tumours in Italy: an example of quantitative assessment of disease burden and preventive strategies

Female tumours (ie cancers of the female genital tract and breast) represent alone about 40% of new cases and 30% of cancer deaths in Italy (approximately 44,500 new cancer diagnoses and 17,800 deaths in 1991). An attempt to identify major issues in the primary and secondary prevention of these malignancies has disclosed several important points. Firstly, concerning epidemiology, excesses of mortality from cancers of the breast and ovaries exist in the northern part of Italy as compared to the centre and south, whereas mortality rates from uterine cancer are almost equally distributed. However, a tendency towards increasing similarity of various Italian regions emerges. Risk factors most amenable to intervention are overweight, contraceptive methods and dietary habits. Secondly, concerning screening, the number of mammograms (about 552) and the number of Pap smears taken every year (about 4 million) are approximately sufficient to provide a complete coverage of the target subset of the female population as concerns breast and cervical cancer screening. Still, on account of no one carrying out primary call procedures and checks, the actual situation is unsatisfactory. The present article, in addition to quantifying the present status of female cancer prevention in Italy, tries to define a framework for similar exercises in other European countries.

[Problems of codification of cause of death: comparison of the mortality data of the ISTAT and the Regional Mortality Registry of Tuscany]

A two-part study was undertaken to assess the comparability of the coding of underlying cause of death between ISTAT (Central Statistics Office providing "national" mortality statistics) and RMR (Mortality Registry of Tuscany Region providing "local" mortality statistics). In Part I was compared mortality data of the Province of Florence (years 1985-1986) from the files of ISTAT with those of RMR. The source of the cause of death is the same for both systems (ISTAT certificate), but the data collection and coding of RMR are different from those of ISTAT. In Part II was compared a set of 219 Tuscany death certificates (year 1988) coded by ISTAT and RMR. The results showed an high degree of completeness of RMR (only--0.65% vs. ISTAT) and a satisfactory level of correspondence in the number of deaths for circulatory diseases, for neoplasms and for cancers of most important sites (lung, stomach, intestine, pancreas, breast). Discrepancies were found for some other diseases; for some of these causes of death, also age-adjusted mortality rates showed discrepancies (for example ischaemic heart disease). The cause of these differences have been analyzed.

Cancer in Italian migrants

Migration of Italians to other parts of the world has a long history and has involved very large numbers of individuals. The study of the health consequences of this migration is made possible by the availability of statistics on mortality and morbidity, both in Italy and in the host countries, and of social and economic information on the various Italian communities abroad. The results of the major studies are reviewed, comparing the rates in immigrants with those in the host countries and in Italy. The differences in cancer rates between Italian and local-born populations--for stomach cancer in both sexes, and for cancer of the colon, lung, and breast in females, and for prostate cancer--are consistent with the direction of differences between rates in Italy and those in the host countries. For colon and rectum cancer in males, there are unexpected findings in most of the United States' studies. Analysis by duration of residence shows changes in the risk for several sites in males, but not in females, according to length of stay in the host country. This finding possibly reflects greater stability of habits and lifestyle in females compared to males.

[Mortality according to the birthplace in a Turin longitudinal study]

Mortality 1981-85 in the Turin Longitudinal Study population, 25-74 years old, was analyzed according to selected geographic areas of birth and socioeconomic status. People born in the Southern Regions and in the Isles, when compared with people ever resident in Turin, have low mortality from malignancies and accidents and in general from all causes of death but respiratory diseases. People born in the North-Eastern Regions have high mortality, mainly due to malignancies, and respiratory and digestive diseases. Such differences are stronger among men in low socio-economic status and tend to weaken with time from migration.

[Analysis of temporal distribution of suicides. Methodological notes on comparison of dates of death and dates of suicidal act]

The short-term temporal cycles in the frequency of suicide for the Province of Florence 1985-1987 has been analyzed. The authors initially present a comparison between the Date of Suicidal Act and the recorded Death Certificate Date. In their data the difference, still debated in the literature, appears of no practical importance. The results show that suicides peak on Spring and Fall, with a temporal variation with regard to the first decade of the month, high at the beginning and low at the end. No evident pattern has been explained by day of the week, unlikely any reports from the literature. On the contrary, the effect of the National Holidays are striking, showing a decrease on the holidays and a sharp rise on the subsequent day.

A case-referent study of lung tumors in non-asbestos textile workers

A case series in the Province of Florence showed an increased risk of mesothelioma in textile workers (nonasbestos) and a survey of working conditions confirmed potential exposure to asbestos. In order to investigate the risk in textile workers, including some specific job titles, a case-referent study on lung tumors was carried out. The lung cancer cases included 441 males with histologically confirmed primary lung cancer during the period 1980-1983. Referents included 1,075 males selected from two hospitals and matched for age, sex, and smoking habits. Those who had "ever worked" in the textile industry showed an adjusted odds ratio of 1.52 (95% C.I. 1-2.25) compared with other "industrial workers." This moderately increased risk is maintained in selected jobs in the textile industry. An analysis of the modifying effect of time factors showed an increased risk in the period of 15-35 years from the date of first employment in the industry. The results support the hypothesis that a probable risk of lung cancer in textile workers in the Prato area was related to asbestos exposure.

A case control study of lung cancer in Florence, Italy. II. Effect of migration from the south

Risk of lung cancer related to region of birth in Italy was investigated among migrants to Florence, in a case control study of all histologically confirmed incident cases of primary lung cancer in a three year period in that city (n = 376). Controls (n = 892) were patients in the same hospital of similar age, sex, date of admission, and smoking status with discharge diagnoses other than lung cancer or suicide. Information on place of birth and year of migration to Florence was collected directly from each subject, along with a detailed occupational history. Logistic regression models were used to calculate the odds ratio for birth in the south of Italy relative to birth elsewhere. Male migrants from the south have an odds ratio of lung cancer of 0.5 (95% limits 0.3 to 0.7) relative to those born elsewhere. This "protective effect" is not explained by smoking or by any known occupational risk. The risk is lowest among those born on the island of Sicily (odds ratio 0.2 compared to those born in the centre-north).

A case control study of lung cancer in Florence, Italy. I. Occupational risk factors

A case control study of lung cancer in Florence, Italy was performed to investigate occupational risk factors for both men and women. The case series (n = 376) comprised all incident, histologically confirmed cases of primary lung cancer occurring in a three year period. Controls (n = 892) were patients in the same hospital of similar age, sex, date of admission, and smoking status with discharge diagnoses other than lung cancer or suicide. A detailed occupational history was collected from each subject directly. Logistic regression models were used to calculate odds ratios for specific occupations compared to all others. Among men, the lung cancer risk for bricklayers using firebrick and other refractory materials was elevated (adjusted odds ratio 6.5, 95% limits 2.1 and 20.9). Female hat makers, probably exposed to arsenic while making felt hats, had an elevated risk of lung cancer (6 cases versus 0 controls, p = 0.01). Risks in other occupations are discussed.

Risk factors in male infertility: a case-control study

A case-control study was undertaken to evaluate environmental risk factors potentially involved in male infertility. One hundred twelve azoospermic or oligospermic subjects and 127 controls were interviewed, before sperm count results were available, about coffee and alcohol consumption, smoking habits, x-ray exposure, usual sitting posture, drug consumption, other nonoccupational risk factors, socioeconomic status, education level, and occupational history. An unmatched analysis was then conducted. None of the occupational risk factors appeared to be related to azoospermia or oligospermia. A high relative risk was associated with (1) occupation in the radioelectric industry, (2) nonsedentary clerical workers, (3) clerical work in the typographic industry, and (4) occupation in the textile industry, but none of these figures were statistically significant. Because of the population from which cases and controls were drawn, certain occupational risks could not be investigated in this study, e.g., exposure of agricultural workers to chemicals.